Afraid of C-Section, Episiotomy

onSunday, September 9, 2007

I was hoping some of you might have better knowledge of how and when these procedures are done. It doesn’t seem to me like a c-section would ever be necessary, unless the baby was breech or blocked (vasa previa), and that an episotomy would only be necessary if the baby’s oxygen supply was in jeopardy. I’ve read that rates of both surgeries are high, and that they’re often done when labor is taking too long. My mother was in labor for 28 hours with my brother, and fortunately no surgeries were needed. I’m worried that having a long labor, on top of being insured by the state, may lead my doctor to decide that it’s been long enough. I’m willing to live with the possible scars of carrying a baby, but not those of an unwanted surgery (or two). Is there any way to express in writing your intentions or to legally prevent these procedures..?

I already replied to this in an e-mail, but wanted to say it here again – check with ICAN (International Cesarean Awareness Netowrk) at http://www.ican-online.org for more info and support in regards to c-sections. They are incredibly knowledgeable and very kind to all mothers concerned over the rising c-section rates in the US.

My own fear of an unnecessary c-section or other interventions lead me to persue natural childbirth. I highly recommend the Bradley Method childbirth classes (www.bradleybirth.com). A couple books to read are The Thinking Woman’s Guide to a Better Birth by Henci Goer and Natural Childbirth the Bradley Way.
I also hired a doula (www.dona.org) for further support.

The end result for me was a drug-free, vaginal delivery with minimal interventions in a hospital setting with a supportive OB. (I didn’t even have an IV!)

I was also really afraid of having an episiotomy or an emergency c-section. Fortunately, I didn’t end up getting either, but I think if you’re concerned it’s a good idea to educate yourself about what you can do to avoid those situations.

Like Bonnie said, ICAN has information about avoiding an unnecessary c-section. To help avoid an episiotomy, there are a couple things you can do. First, let your doctor know that you don’t want one and put that in your birth plan.

Second, you can try perenial massage to make sure your perineum is less likely to tear.

I was very much like you. I really wanted to avoid c-section and episiotomy if possible, however I ended up having an episiotomy, because had I not done it, my clit would have ripped in half. The doctors waited until the last possible second to make the decision, but was evident that I was going to tear upward and I would never have the same sensation with sexual activity again had my clit torn in two. I’m thankful they did it. The recovery wasn’t bad at all for me. Good luck though I hope things go the way you hope so you are able to avoid these procedures!

Personally I dont agree with the fact that you said ” a csection is never really necesary” only under a few options. my daughters were both csections, my first was because i was in labor over 24hrs with ruptured membranes, and they were afraid of infection and my second was scheduled but came 6 weeks early. it is really unfair to say that they are not necessary, i am just as much of a mother, regardless of how my children came into this world

I know it’s scary to think about having someone poking around your bod. w/sharp objects. I, too, swore w/my 1st pregnancy that I would have a natural, drug free, vaginal birth. But it didn’t work out that way. I ended up with a c-section (after a long labor that went no where) & it turned out to be the best thing for my precious little baby—she was dangerously tangled in her (very long) umbilical cord. It was wrapped around her neck & around her shoulder/arm and around her body many times. In fact they couldn’t even remove her head first or it would have ripped the placenta out…she was pulled out by one foot. If she hadn’t been taken out surgically she would have been strangled by the cord as she descended through the birth canal. I felt like a total failure for weeks after because I didn’t deliver naturally. However, I came to realize that the most important thing is that end result, she entered this world safe and sound and alive. I know it’s hard not to want to control everything that happens in what is likely to be the most important experience of your life. Just try to do what’s best for you and your little one & make sure you have a Dr. or midwife that you absolutely trust & feel comfortable with…tell them your concerns & if they don’t give you satisfactory answers find someone who will. Best of luck to you, Mama!

Hire a doula! Many take clients free of charge from time to time, or find a student doula who cannot charge, but has been trained!

Going into birth with anxiety is not a good start. Research your hospital’s rates for each procedure, get familiar with your OB’s practices, etc. Knowledge is the best defense against both fear, and unwanted procedures.

One thing they don’t like to tell you – you can deny any procedure at any time. Also, many doctors who are big on episiotomies do them without a word. Be up front and make it known that you are not okay with the cut! A doula will support your wishes and when the time comes, give them another voice (because you will be OCCUPIED!). Having SOMEONE there to back you up can be CRUCIAL to avoiding interventions you don’t want.

“You can have an easy birth or a hard birth, a long labor or a short scheduled c-section, a birth that involves many specialists and lots of modern technology or one that’s just you pushing out your baby in your bathroom, the “perfect” induced epidural vaginal birth or an emergency c-section, but as long you’re treated with respect and as the most important person in the room, it’s a good birth.”

If you want to browse through lots and lots of opinions and advice on these matters, head over to mothering.com/discussions. The magazine has an amazing forum where people really have a lot of combined knowledge.

I think that if the end result is a healthy baby and mama, that sometimes a c-section or episiotomy is necessary.

My situation was quite similar to Savannah’s with her first daughter (ruptured membranes, stalled labor). Towards the end of the second day of labor, my son’s heart started slowing down during contractions, so we elected to have a c-section. I don’t regret my decision, even though my scar gets in the way of some yoga poses. That’s the only minor glitch, 17 months later.

Here’s my advice for avoiding unnecessary medical interventions:
1. KEGEL KEGEL KEGEL! And walk at least three miles a day. Get fit. Stay fit.
2. Educate yourself. Learn about ways to manage discomfort in labor (try to avoid an epidural/drugs if you can manage your labor without it), relaxation techniques, the value of staying home and walking in the early stages of labor, ALL the different positions to push in (for me, hands and knees – think pooping dog – was very effective, and it lessens the chance of tearing in comparison to some other positions). Read about the natural alignment plateau (labor can often appear to be stalled for hours at 5 or 6 cm, and then a woman dilates the rest of the way in 20 min.).
2. Make a birth plan, and make sure the labor doc. or midwife and nurses know what is in it. Get another person to stay with you for labor – partner, doula, mom – who can also be an advocate for your wishes if you need one.
3. Read about reasons why you might need a c-section; IF a situation comes up that is a genuine medical emergency (cord prolapse, placental abruption, prolonged fetal distress, ???) you will at least feel like you aren’t being bamboozled by an impatient doctor. You should feel like you know the difference between what is a true danger to you or babe vs. something that is more of a wait-n-see situation.
4. Remember, it’s YOUR body, and YOUR baby, and you can refuse any procedure they offer if you sign an AMA (against medical advice). But, it’s better to work with your provider, make your wishes known, make sure they give you a straight story on the situation, your options, and the consequences of choosing any of them. Ultimately, you want to have a healthy mama and healthy baby, and no matter how the baby arrives, you will be amazed — birth is a really magical event, and you will be over the moon when your babe arrives and you get to meet him/her!

Being aware of why these procedures happen by educating yourself is probably one of the best things you can do. Most of the time these procedures are done because the doctor decides things aren’t moving along in a timely enough fashion. Find out if you can have a midwife who will be a bit more supportive of your desires for a birth with minimal intervention. I also highly recommend you have a doula. Lots of doulas will work on a sliding scale or some are working toward their certification so they are low cost.

I’ve had five beautiful babies all in the hospital, all different doctors. My advice to you is simple and does not require you to sign anything or have a home birth. I personally see no reason to go to the hospital until it is absolutely necassary. Just because your water breaks or you have contractions does not mean you need to race off. (using my first as a measure of experience – I spent 17 hrs in the hospital before my little guy entered the world, I went because my water broke)
I waited until my contractions were VERY close each time after that. I did not have short labors but I was only at the hospital for about an hour before birth each time. As for the episiotomy, push when you are supposed to and hold when you can. Telling any decent doctor during birth not to cut you will keep you from getting cut. So my last bit of advice is, if you don’t like your current doctor, or don’t trust him/her, then find one you do. I did that halfway through my fourth and had no regrets.

I think the best thing to do is talk to whoever is assisting you during your birth (be it doctor, midwife, etc).

I went from a planned homebirth to a hospital birth due to meconium in the water which ended up being from a short cord that was wrapped around her neck. Nothing anyone could have done would have prevent it..it just was.

While we did everything we could to prevent a episiotomy, my baby needed to come out NOW because she was starting to show too much distress. Waiting for the stretching would be too risky and she was crowing so doing a c-section was not the best choice (and it was last resort for us).

It wasn’t the birth I dreamed for us, but it was the best possible birth we could have had and it was exactly what and where she needed to be. We have a healthy baby born without drugs and that annoying cut…worth it.

Communicate your desires and do everything possible to get what you want…but sometimes you have to be flexible in the moment. You can always question the doctor and you don’t have to consent if you don’t want to. Make them explain why they feel ___ is necessary. Our midwives served as doulas at the hospital…if you can afford a doula or midwife to be at your side it is nice. They are your advocate and can help you make the best possible decision when unexpected complications may arise.

You are right episiotimies are never necessary, totally proven to be ineffective for any use. C-sections are very rarely necessary and are often the result of incompetant/impatient doctors. I had an emergency c-section and the only emergency was that the doctors had a Christmas party to go to.

Savannah, I don’t think anyone is going to say you are less of a mother because of your surgery but it really is rarely necessary. Although your doctors may have been worried about infection, I think the research behind that reason shows it to be flawed.

Don’t forget it takes on average 15 years for the medical community to implement the latest research into their practices. They are that resistant to change. Another good reason to use a midwife and stay home!

Do a birth plan now. State in there that you DO NOT want either of those procedures unless your baby is in trouble. Discuss episiotomy with your OB several times before labor. Express how opposed you are to it. During labor, make sure your support person knows that you do not want one. Do not let anyone (nurses or doctors) talk you into during the heat of the moment by telling you labor will be over faster if you get cut.

I had an Episiotomy with my first b/c I was talked into it, and I tore with my 2nd and 3rd children. It was much more comfortable healing and quicker with the tears. Some doctors perform Episiotomies routinely and not when they are absolutely necessary. Talk this over with your doctor and find out where they stand.

You are still lucky epistomy is just an option for you. In my country (Poland) epistomy is a standard medical procedure and ALL women who give birth for the first time HAVE to have it. Doctors don’t even ask for permission :P

Jennifer, I understand that your experience with a c-section may have been very negative and in your opinion was unnecessary, there are most definitely times when they are absolutely needed. I had an emergency c-section after being induced and being in labour for 10 hours with no dilation or thinning of the cervix. Once I was opened up, my OB was able to see that this was because of a defect with my uterus that caused part of it to not expand during pregnancy, meaning that my son never would have dropped, and never would have been able to be born vaginally. If I had chosen to ignore my doctor’s advice when she felt like this labour was going on for too long with no progress, my baby definitely would have died and I could have died too.

Yes, sometimes c-sections are given before they are absolutely necessary. I believe this is because of our sue-happy society. If anything goes wrong during a birth, people immediately sue the doctor for malpractice. So doctors are trying to cover themselves by taking action before things become life or death.

And sometimes, maybe just sometimes, we should remember that doctors went to school for 7-10 years in order to gain knowledge to help us. So maybe sometimes we need to remember that they just might know what they’re talking about. I have a healthy, LIVING son because I listened to my doctor’s advice.

Say it every time someone pushes something on you that you don’t want. Even with a birth plan and supportive medical team, you might still wind up railroaded into unnecessary interventions, because that’s how hospitals roll. So say it to them loud and clear: “I DO NOT CONSENT.”

I had hired a midwife for the birth of my son, but unfortunately he didn’t tolerate labor and would have died had he not been taken by c section. His heart rate kept dropping very low and they did everything they could not to have to take him that way. I am so glad they did because even though labor didn’t go the way I had envisioned, I have a beautiful 7 month old son.

katrina i didn’t say there was never a reason for a c-section, just that it is “rarely” necessary. I’m not making this up, there is a ton of research to back this statement.

Yes doctors go to school for years but they are taught that birth is an unnatural disease that needs treating which leads to the use of unnecessary, disproven interventions. That is fact. Doctors are often biased and go with what they are used to or what they believe not what is true.

I’ve been studying this for oh 13+ years, so again I’m not just coming up with this out of my head. It is proven fact. Do your research, that’s all I have to say, I’m not going to debate with you. There’s nothing to debate as this has nothing to do with personal opinion, it’s fact.

No my c-section wasn’t necessary, the equipment was shown to be faulty and when she came out she showed no signs of distress. Not opinion, fact.

I had a c section that saved my little girls life. I had developed pre-e at 29 weeks and made it till 35 weeks when I almost had a siezure and stroke. They went ahead and induced because neither I or my daughter were doing well. They tried for 2 days and then my daughter went into distress and almost died, I knew something was very very wrong and the doctor and monitors confirmed it, they had to get her out immediately. I was only 1 cm dilated so I had an emergency c section. I was planning on a natural birth with no meds, using hypnotherapy but things changed and I am glad that I was flexible because I know my daughter would not have be here today without that.

I was very scared of child birth, my daughter is almost a year old now, but I knew I wanted natural birth. I waited and waited.. and I was 2 weeks overdue when the doctor brought me in to induce me (they have to after 2 weeks because of lack of oxygen to the baby when your overdue.) I was induced and in labour for 14 hours before the doctor said I need a c-section because I was not dilating and they had already broke my water. So I always tell everyone who says they wont have a c-section to be prepared for anything, I wasnt prepared for a c-section at all but its ALWAYS a possibility. Next time I have a baby Im asking for a c-section, I NEVER WANT TO GO THROUGH NEEDLESS 14 HOURS LABOUR EVER AGAIN to be told i need a c-section!

Jennifer, We live in the 21st century. This means we have technology that does and can help us and our children survive birthing situations that would have previously killed us. And while c-sections aren’t always necessary, if someone chooses to have one, so be it. You’re having a child – not a birth! Focus on the baby not the contractions! We could all do with being a lot less judgemental of others actions, and think about our own choices only…